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Designs Bill through Parliament. For this reasonit was agreed that, although the resolutions of theconference are subject to endorsement by the Councilof the British Medical Association, they should, asthe opinion of the conference itself, be communicatedin the meantime to the Ministry of Health, the Boardof Trade, and the medical Members of Parliament.They will be submitted, in addition, to the bodieswhich sent representatives to the conference.

THE BRITISH SPAS:AN APPRECIATION.

STATEMENT No. 3, issued by the British HealthResorts Association,! says that although there aremany waters in the British Islands (Dr. Rutty in1757 described 131 sources of medicinal water inIreland alone), there are at present only 12 actual

spas-that is to say, places where natural medicinalsprings are installed in establishments for medicaluse. The British spas are distinguished from thoseof the Continent by their invigorating and tonic

quality, imparted by the northern island climate.The summer is considerably cooler than at mostcontinental resorts, excepting only those in the Alps.With this temperate quality and the long northerndays is combined a freshness and almost incessantmovement of the air. The medical value of thenorthern moorlands of moderate altitude is com-

parable to that of the Swiss mountains. The influenceof the British climate and of latitude profoundlymodifies the action of water-drinking and baths, andthe reaction of invalids under treatment in fresh andtonic airs is different from that observed in enclosedand sultry valleys. Two main types of spa treatmentare practised in England :

(1) The catabolic type, which aims at increasing elimina-tion from the body by the bowels, kidneys, and skin, aidedby appropriate diet and exercise. This is especially suitablefor patients, whatever the form of their particular disorder,who are sedentary, of good appetite, well-nourished andflorid, often showing signs of congestion and high bloodpressure (hyperpiesia).

(2) The anabolic type of treatment, which aims at increas-ing and improving the nutrition of the body by tonic waters,baths, and regimen. This, again, is especially desirable forchilly and ailing or convalescent persons, usually of poorappetite, thin and ill-nourished, pale, with cold and inactiveskin and poor circulation (poikilothermia).

THERAPEUTIC INDICATIONS.

The medical uses of the British spas are, naturally,not so highly differentiated as in countries wherethere are many varieties of waters. Fortunately, boththese great categories of chronic maladies-the con-gestive and the subnormal-are well treated at allthe British spas. In the north, Strathpeffer, Buxton,and Harrogate offer a frankly tonic summer treat-ment. Woodhall Spa, to the east, is more sheltered.At the Welsh spas, and at Leamington, Cheltenham,and Droitwich in the Midlands, the tonic and seda-tive influences are combined. Bath is the warmestand most sedative of British spas, and eminentlysuited for treatment in winter.The 12 British spas present an interesting variety.The hot springs of BATH, rising at 120 °F., were used

by the Celts and Romans, and there was a Bath hospitalin the sixth century. Their diuretic and solvent effects are

1 The statement is signed on behalf of the Medical AdvisoryCommittee of the Association by Dr. R. H. Elliot, Sir ThomasHorder, Dr. Robert Hutchison, Dr. E. P. Poulton, Sir HumphryRolleston, Sir William Willcox, Dr. R. A. Young, Dr. R.Fortescue Fox (chairman), and Dr. W. S. C. Copeman (hon.secretary).

enhanced by baths of various kinds. Deep pools of thermalwater, besides douches and whirlpools, are used for therelief of pain and stiffness in many chronic rheumaticaffections, and for the treatment of wasted and paralysedlimbs, as well as injuries. The warm winter climate rein-forces the effect of the baths.BRIDGE OF ALLAN. in the Lowlands of Scotland, has been

recently rediscovered as a spa. The calcium salt watersare used for rheumatism and by inhalations for catarrh,and the mild and equable climate makes it a resort for allseasons.

BuxToN, in Derbyshire, stands 1000 feet above sea-level,and, like Bath, was known to the Romans. The warm bluewaters, from which the name of " The Blue Spa " is derived,have been used for the rheumatic poor since the sixteenthcentury, and the fine hospital is a lasting monument totheir value. Buxton is a natural Centre of Convalescence."

Both CHELTENHAM and LEAMINGTON, with TUNBRIDGP,WELLS (no longer a spa) were fashionable centres for water-drinking 100 years ago. The first, with its uncommonalkaline waters, is especially useful in intestinal and liverdisorders. Both are useful salines, in sheltered localities,suitable for spa treatment at all seasons and for delicateand elderly persons and those returned from tropicalcountries.The brines of DROiTWicn&mdash;<SwKB of the Romans-are

ten times as strong as sea water, and are used externallyfor many forms of rheumatism, re-educational movementsin the bath now forming part of the cure.HARROGATE, on a bracing Yorkshire moor, has a remark-

able outcrop of sulphur, saline, and iron springs, firstdescribed in 1626, and has had its excellent spa hospitalfor more than a century. The spa claims with some justiceto counteract the effects of a sedentary life, and especiallythe disorders of the digestion and liver.LLANDRINDOD WELLS, in central Wales, has also a

pleasant moorland climate, and its " anti-catarrhal " saltwaters are of curative value for catarrhs of the stomachand bowels, as well as a tonic in anaemia and debility.The neighbouring LLANWRTYD, too little known, possessesan abundant source of sulphuretted water.TREFRrw, in Carnarvonshire, is a little-known spa,

possessed of a nearly unique acid-iron water. Given inspoonfuls and externally in compresses and baths, it is apowerful stimulant in certain forms of arthritis and ansemia.STRATHPEFFER SPA, in the Highlands, is the northernmost

of the British stations, and has some of the strongest sulphurwaters in Europe, as well as an iron spring. The tonic-sedative air is very favourable for repose and recuperation.WoonFInLL SPA, in Lincolnshire, has a dry and bracing

air. The salt waters, with a little bromine and iodine, arediluted for drinking and are used externally for rheumatismand diseases of women, and by inhalation for respiratorycatarrh.

Altogether the British spas comprise most of thewaters which should be of service in preventingill-health and in relieving the disorders associatedwith a northern climate.

SPECIALISATION.

No one country contains every natural provisionfor health. There are no arsenical waters in England,and children and others for whom such waters areconsidered desirable must be directed elsewhere.Alkaline waters, which are greatly resorted to inother countries, are little used in England.The British spas have not specialised to the same extent

as those on the Continent. For instance, treatment bydiuresis (flushing of the kidneys) has not been differentiatedand systematised, although there are many available waterswhich have diuretic properties, such as those of MALVERN,ILKLEY, MATLOCK, BRACE BOROUGH SPA. There is no healthresort that is mainly or exclusively concerned with cardio-vascular cases with the various procedures recommendedfor these too prevalent conditions. Treatment in the homecountry is especially desirable for cases of that kind. Again,there is no spa chiefly devoted to asthma and respiratoryaffections, although useful methods are now employed atmore than one of the British spas. In other countries aspa technique has been developed for these ailments, inwhich varied modes of treatment are combined-a systemof inhalations being used simultaneously with waters andgeneral and local baths.

Many classes of health seekers may confidentlyexpect to benefit by British waters and baths. These

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include sufferers from chronic rheumatic disorders,gouty manifestations, arterial hypertension, dys-pepsia and indigestion in their various forms,congestive or catarrhal, whether in sedentary or

convalescent persons, and from nerve exhaustion andanxiety states. In addition to these are the manyover-tired people, showing signs of strain and failinghealth, who need more than a holiday every summer.Adequate and complete treatment is available forall these conditions at the British health resorts.From the international standpoint, therefore, the

spas of Britain take their place as a group of northernstations. They offer a particular type of treatment,which, reinforced by the island climate, is more

stimulant and less sedative than spa treatment onthe Continent. With this dominant character thedifferent members of the group serve a good varietyof medical uses.

HUGHLINGS JACKSON MEMORIALMEDAL.

PRESENTATION TO SIR CHARLES

SHERRINGTON.

ON May l9th,at the annual meeting of the Sectionof Neurology of the Royal Society of Medicine,Dr. Stanley Barnes, as president of the section, hadthe pleasant duty of introducing the first recipientof the Hughlings Jackson Memorial Medal. Herecalled the foundation and history of the lectureship,the first lecture being given in 1897 by Dr. HughlingsJackson himself to the old Neurological Society,and subsequent lectures being delivered at irregularintervals by such men as Hitzig, Broadbent, Horsley,Gowers, Head, and Dana. About twenty years agoTooth had suggested raising a fund to endow thelectureship, but no action was taken and the matterwas forgotten. In 1931 Sir Charles Sherringtongave the lecture, and at a dinner given in his honourthe same evening Mr. Leslie Paton, then presidentof the section, proposed that money should be raisedto endow a medal and give an honorarium to thelecturer. The proposal had an enthusiastic receptionand a satisfactory outcome, and that evening theywere in a position to present the first medal and acheque for 100 guineas to Sir Charles Sherrington.Dr. Barnes noted that among those present wasSir James Crichton-Browne, Dr. Hughlings Jackson’soldest surviving friend, and called on him to say afew words. Sir James spoke of his first meeting withJackson 70 years ago, of their subsequent association,and of the early papers published by Jackson in themedical Reports of the West Riding Asylum. Whenhe (the speaker) had to leave Yorkshire, these reportsunder his editorship ceased to be published, andthe need for some similar journal led to the foundationof Brain, and out of Brain grew the NeurologicalSociety, of which Hughlings Jackson was the first

president. Sir James Crichton-Browne recalledJackson less as a great neurologist and physicianthan as a dear friend. Sir Charles Sherrington haddone magnificent work on the lines laid down byJackson, with advantages for research which Jacksondid not possess.

Dr. T. Watts Eden, president of the society, thenpresented the medal and cheque to Sir CharlesSherrington, and also his diploma as an honorarymember of the Section of Neurology. It was appropriatethat the work of one of the greatest clinical observersthe world had ever seen should be thus commemorated.

Sir Charles Sherrington’s investigations had discloseda domain of nerve function which was hardly dreamedof in Hughlings Jackson’s time, and the happyassociation of clinical and experimental work wasexemplified on this occasion.

Sir Charles Sherrington, who was received withprolonged applause, expressed his gratitude to thesociety and to all those at home and abroad who hadjoined in the inauguration of the medal and hadhonoured him by this presentation. He spoke ofHughlings Jackson’s happiness in being able to com-bine work in the laboratory with work at the bedside ;he, himself, had found it impossible to get far outsidethe walls of the laboratory, and was all the more

appreciative of the fact that they had singled outfor this honour one who had been working on anarrow line. The presence of Sir James Crichton-Browne was an added pleasure, inasmuch as he hadbeen a colleague and friend of Hughlings Jacksonlong years ago.

After Mr. Leslie Paton had presented two replicasin toned silver to Dr. Watts Eden for the RoyalSociety of Medicine, Dr. Stanley Barnes thanked thetreasurer of the fund, Dr. Wilfred Harris, in thename of the Section of Neurology for his work forthe fund.

Dr. Harris, in reply, said that when he went up toCambridge as an undergraduate in 1888, Sir JamesCrichton-Browne had recently been elected presidentof the Neurological Society, third in succession fromHughlings Jackson. At Cambridge, under MichaelFoster, he found that the third volume of Foster’sPhysiology on the Central Nervous System, a monu-mental work, was written entirely by Sherrington.As the students were supposed to know the whole ofthis for the tripos examinations, he thought of

Sherrington in those days perhaps with somewhatmixed feelings. Five years later, after leavingCambridge, he became Dr. Hughlings Jackson’shouse physician, and he had always looked on

Jackson’s and Sherrington’s names as meaning morefor him in neurology than any others. It wouldreadily be understood, therefore, how intenselyinteresting it had been for him to aid in gilding theinscriptions of two names indelibly written in theannals of the Section of Neurology.

IMMUNISATION AGAINST DIPHTHERIA.

RESOLUTIONS OF THE LONDON CONFERENCE.

AT a conference of 21 experts under the chairman-ship of Dr. Th. Madsen, held in London in June, 1931,reports were presented of studies in immunisation

against diphtheria carried out on a uniform plan innine European countries. On the basis of the infor-mation submitted to it the conference formulatedcertain practical conclusions designed to help healthadministrations in the campaign against diphtheria.The text of these resolutions, which have receivedthe approval of the Health Committee of the Leagueof Nations, is given in the first number of the new

Quarte1’ly Bulletin as follows :-1. Immunisation against diphtheria, when carried out

under suitable conditions and with efficient prophylactics,effects a large reduction in the diphtheria mortality- andmorbidity-rates among children thus treated. This isproved by studies carried out under strictly comparableconditions, such as those observed during the recentinquiries.

2. The reactions sometimes observed after the injectionof diphtheria prophylactics give no cause for alarm and